Four years ago this February, an entire community was devastated in Prince George’s County, Maryland, just outside Washington, D.C., when 12-year-old seventh grader Deamonte Driver died after complications from a tooth abscess. His mother Alyce, who worked at low-paying jobs, had searched for a dentist to treat Deamonte’s toothache who would accept Medicaid, but she was unsuccessful. Ultimately, Alyce took Deamonte to a hospital emergency room, where he was given medicine for a headache, sinusitis, and a dental abscess and sent home. But his condition soon took a turn for the worse, and he was back at the hospital being rushed to surgery where it was discovered that bacteria from his abscessed tooth had spread to his brain. Heroic efforts were made to save him, including two operations and eight weeks of additional care and therapy totaling about $250,000, but it was all too late. Deamonte died on February 25, 2007 -- when his life could have been saved by a routine dental visit and an $80 tooth extraction.

Tooth decay is the single most common chronic childhood disease -- five times more common than asthma and seven times more common than hay fever. Dental care is an often overlooked but critical component of comprehensive health care for children. Pain and suffering due to untreated dental disease can lead to problems in speaking, eating, and learning. For children caught without dental coverage, dental problems can quickly become more than “just” a toothache. Research shows children who lack basic dental care miss more days of school and see their overall health suffer. In fact, children miss more than 51 million hours of school each year due to dental-related illnesses. According to the Children’s Dental Health Project, “The oral health of children has a significant and lasting impact on the productivity of our existing and future employees and leaders... Untreated tooth decay is progressive and can be devastating to children's long-term health, educational achievements, self image, and overall success.” And as Deamonte’s death showed, in extreme cases lack of dental care can even lead to fatal complications.

Health insurance coverage is a strong predictor of access to dental care. But despite its importance, dental coverage is largely excluded from many private insurance plans, and pediatric dentists can be difficult to find. For every child without health insurance, there are 2.6 children without dental coverage. Uninsured children are 2.5 times less likely than children with insurance (public or private) to receive dental care.

Since Deamonte’s death, Congress has recognized dental coverage as an important component of comprehensive care for children, enacting major policy changes to improve dental coverage for children. In 2009, the reauthorization of the Children’s Health Insurance Program (CHIP) required states to provide dental coverage to enrolled children, and gave states the option to provide dental benefits to certain children who do not qualify for full CHIP coverage. In 2010, the health reform bill known as the Affordable Care Act required that all insurance plans to be offered through new health insurance exchanges starting in 2014 include oral care for children, and prohibited these insurers from charging out of pocket expenses for preventive pediatric oral health services. These two new requirements alone will give millions of children financial access to dental health services, many for the first time.

Other provisions in the Affordable Care Act will help train more dental health providers. A new report by the Children’s Dental Campaign of the Pew Center on the States emphasizes the importance of availability of providers: the authors calculate that more than 31 million Americans are “unserved,” which means they live in areas where they can’t find a dentist in or near their community. In seven states, more than 20 percent of the population can’t find a dentist.

Maryland, Deamonte’s home state, has become a model for reform. One innovative solution helping to reach some underserved children like Deamonte is mobile dental clinics staffed by volunteer dentists, and in November the Deamonte Driver Dental Project Mobile Unit, a large van now equipped as a three-chair children’s dental clinic, made its first stop by spending the day at Deamonte’s old school.

These victories are all key steps in the right direction, and part of the solution still needed in order to make sure all children -- poor and wealthy, rural, suburban, and urban -- receive the dental health care they need to survive and thrive.